title: Apnea in children hospitalized with bronchiolitis.
abstract: OBJECTIVE
  To identify risk factors for inpatient apnea among children hospitalized with bronchiolitis.
  
  
  METHODS
  We enrolled 2207 children, aged <2 years, hospitalized with bronchiolitis at 16 sites during the winters of 2007 to 2010. Nasopharyngeal aspirates (NPAs) were obtained on all subjects, and real-time polymerase chain reaction was used to test NPA samples for 16 viruses. Inpatient apnea was ascertained by daily chart review, with outcome data in 2156 children (98%). Age was corrected for birth <37 weeks. Multivariable logistic regression was performed to identify independent risk factors for inpatient apnea.
  
  
  RESULTS
  Inpatient apnea was identified in 108 children (5%, 95% confidence interval [CI] 4%-6%). Statistically significant, independent predictors of inpatient apnea included: corrected ages of <2 weeks (odds ratio [OR] 9.67) and 2 to 8 weeks (OR 4.72), compared with age ≥ 6 months; birth weight <2.3 kg (5 pounds; OR 2.15), compared with ≥ 3.2 kg (7 pounds); caretaker report of previous apnea during this bronchiolitis episode (OR 3.63); preadmission respiratory rates of <30 (OR 4.05), 30 to 39 (OR 2.35) and >70 (OR 2.26), compared with 40 to 49; and having a preadmission room air oxygen saturation <90% (OR 1.60). Apnea risk was similar across the major viral pathogens.
  
  
  CONCLUSIONS
  In this prospective, multicenter study of children hospitalized with bronchiolitis, inpatient apnea was associated with younger corrected age, lower birth weight, history of apnea, and preadmission clinical factors including low or high respiratory rates and low room air oxygen saturation. Several bronchiolitis pathogens were associated with apnea, with similar apnea risk across the major viral pathogens.
authors.affiliation: Department of Pediatrics, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128. Alan.Schroeder@hhs.sccgov.org.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Schroeder
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Mansbach
authors.forename: Michelle
authors.initials: M
authors.lastname: Stevenson
authors.forename: Charles G
authors.initials: CG
authors.lastname: Macias
authors.forename: Erin Stucky
authors.initials: ES
authors.lastname: Fisher
authors.forename: Besh
authors.initials: B
authors.lastname: Barcega
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.forename: Janice A
authors.initials: JA
authors.lastname: Espinola
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Piedra
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D001049:Apnea / Q000175:diagnosis / Q000453:epidemiology*; D001988:Bronchiolitis / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D047928:Premature Birth / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors
keywords: apnea; bronchiolitis; hospitalization; infants; viral infections